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Ronald Klein, MD; Barbara E. K. Klein, MD; Scot E. Moss, MA; Karen J. Cruickshanks, PhD

Arch Ophthalmol. 1999;117:1487-1495.

Objective  To investigate the association of ocular disease with all-cause and cause-specific mortality in a diabetic population.

Design  Geographically defined population-based cohort study.

Setting  An 11-county area in Wisconsin.

Study Population  Participants were all younger-onset diabetic persons (diagnosed as having diabetes at <30 years of age and taking insulin) and a random sample of older-onset diabetic persons (diagnosed as having diabetes at 30 years of age). Diabetic retinopathy, macular edema, visual acuity, and cataract were measured using standardized protocols at baseline examinations from 1980 to 1982, in which 996 younger-onset and 1370 older-onset persons participated. Participants were followed up for 16 years.

Main Outcome Measure  All-cause and cause-specific mortality as determined from death certificates.

Results  In the younger-onset group, after controlling for age and sex, retinopathy severity, macular edema, cataract, history of cataract surgery, and history of glaucoma at baseline were associated with all-cause and ischemic heart disease mortality. In the older-onset group, after controlling for age and sex, retinopathy and visual impairment were related to all-cause, ischemic heart disease, and stroke mortality. No ocular variable under study was related to cancer mortality in the older-onset group. After controlling for systemic risk factors, visual impairment was associated with all-cause and ischemic heart disease mortality in the younger-onset group. In the older-onset group, retinopathy severity was related to all-cause and stroke mortality, and visual impairment was related to all-cause, ischemic heart disease, and stroke mortality.

Conclusions  Presence of more severe retinopathy or visual impairment in diabetic patients is a risk indicator for increased risk of ischemic heart disease death. Presence of these ocular conditions may identify individuals who should be under care for cardiovascular disease.

From the Departments of Ophthalmology and Visual Sciences (Drs R. Klein, B. E. K. Klein, and Cruickshanks and Mr Moss) and Preventive Medicine (Dr Cruickshanks), University of Wisconsin Medical School, Madison.

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